Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoidblack mamba

Abstract

A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid () 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid , technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.

Broad and Region-Specific Impacts of the Synthetic Cannabinoid CP 55,940 in Adolescent and Adult Female Mouse Brains

“…CP 55,940 and other synthetic cannabinoids are highly potent and efficacious CB 1 agonists associated with extreme psychological and physiological effects ( Hudson and Ramsey, 2011 ; Castaneto et al, 2014 ; Fantegrossi et al, 2014 ; Davidson et al, 2017 ; Moeller et al, 2017 ; Samra et al, 2017 ; Manix et al, 2018 ). While there are similarities in some physiological effects between cannabis and synthetic cannabinoids, life-threatening reactions which have been attributed to synthetic cannabinoids are not associated with cannabis use alone ( Underwood, 2015 ; Davidson et al, 2017 ; Manix et al, 2018 ).…”

“…Some of the effects of these compounds are severe and detrimental to public health ( Castaneto et al, 2014 ; Müller et al, 2015 ). There are reports of heart attacks, kidney failure, psychosis, and even deaths in people who consumed synthetic cannabinoids ( Davidson et al, 2017 ; Moeller et al, 2017 ; Samra et al, 2017 ; Manix et al, 2018 ). Tragically, most of these people were young and apparently healthy ( Underwood, 2015 ; Samra et al, 2017 ; Manix et al, 2018 ).…”

“…There are reports of heart attacks, kidney failure, psychosis, and even deaths in people who consumed synthetic cannabinoids ( Davidson et al, 2017 ; Moeller et al, 2017 ; Samra et al, 2017 ; Manix et al, 2018 ). Tragically, most of these people were young and apparently healthy ( Underwood, 2015 ; Samra et al, 2017 ; Manix et al, 2018 ). Given unknown effects on the developing brain, the prevalence of synthetic cannabinoid use amongst teenagers and young adults is of particular concern.…”

Atypical demyelinating lesions due to synthetic cannabinoids: a case report

“…(12) There are some case reports describing toxic changes following illegal drug use, 2C-E, black mamba, but still no consensus on entitling these changes. (9,11,13) Some authors referred to it as toxic leukoencephalopathy or acute disseminated encephalomyelitis (ADEM), but all agree that these changes are myelinopathic changes rather than ischemic changes. The MR images and clinical features of our case are quite similar to ADEM, but we preferred to define it as an atypical demyelinating lesion because it was seen after SBS use.…”

Cannabis und synthetische Cannabinoide – eine nicht nur radiologische Übersicht

“…In schwerwiegenden Fällen mit vielfachen generalisierten Anfällen ist an eine ADEM zu denken, insbesondere wenn es zu weiteren Komplikationen wie verstärkter Agitation, Aphasie oder Hemiparese kommt. Der radiologische Verdacht auf eine ADEM ergibt sich durch den Nachweis asymmetrischer hyperintenser Herde, die gleichermaßen in der grauen und weißen Substanz vorkommen können [43].…”